Document Type

Working Paper

Publication Date



long term care services, LTSS, MRHRC, USM Aging Initiative, Health and Wellness


Post-acute and long term care services for older persons and persons with serious disabilities are responsible for an ever-larger share of the costs of the Medicare and Medicaid programs. The need to control demand and expenditures has led states and the federal government to seek new managed care strategies, such as capitated financing and coordinated case management, that integrate the financing and delivery of primary care, acute and long term care services. Integration and managed care are viewed as encouraging a substitution of less costly and more appropriate home and community-based services for high cost medical and long term care services which have been heavily funded under fee-for-service financing systems. From a rural perspective, the development of organizational and delivery systems which better integrate and manage primary, acute and long term care services may help address long-standing problems of limited availability of and access to long term care services. Over the past decade, many rural hospitals have developed or acquired postacute care services such as home health agencies and/or skilled nursing facilities as a strategy for managing their inpatient use and diversifying their revenue base. And some rural hospitals have ventured into the world of long term care as well, offering assisted living, adult day service programs, respite programs, or sponsoring meal sites for older persons. The growing involvement of rural hospitals in the post-acute and long term care services may provide important opportunities to develop more integrated acute and long term care systems in these communities. Notwithstanding the significant challenges, there are emerging examples of rural networks and managed long term care programs that offer important insights into the opportunities and challenges of using these approaches in rural settings. This paper discusses the concept of integrated acute (medical) and long term care service networks, some of the model programs that have been demonstrated, the challenges that health care providers, state policymakers, and others have faced in developing these new integrated structures, and the future of integrated approaches in rural areas. The paper updates and expands upon key findings, insights, and conclusions from a recent study of several of these programs (Coburn et al. 1997).


doi: 10.1177/073346480102000402

Working Paper #20

Funding Organization

Federal Office of Rural Health Policy, Health Resources and Services Administration, DHHS

Grant Number




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